Provider Demographics
NPI:1760854152
Name:WATERS, LORI MARIE (MA)
Entity Type:Individual
Prefix:MS
First Name:LORI
Middle Name:MARIE
Last Name:WATERS
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1485 LINAPUNI ST RM 105
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96819-3575
Mailing Address - Country:US
Mailing Address - Phone:808-843-5312
Mailing Address - Fax:
Practice Address - Street 1:1485 LINAPUNI ST RM 105
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96819-3575
Practice Address - Country:US
Practice Address - Phone:808-843-5312
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-24
Last Update Date:2015-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1212101YP2500X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health